The medical cost and outcome of desensitization protocol in kidney transplantation recipients with high immunological risks.

Autor: Maenosono R; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.; Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan., Unagami K; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.; Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan., Oki R; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.; Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan., Fujiwara Y; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.; Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan., Banno T; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Okada D; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Yagisawa T; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Kanzawa T; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Hirai T; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Omoto K; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Hanafusa N; Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan., Azuma H; Department of Urology, Osaka Medical and Pharmaceutical University, Osaka, Japan., Takagi T; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan., Ishida H; Department of Organ Transplant Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Jazyk: angličtina
Zdroj: International journal of urology : official journal of the Japanese Urological Association [Int J Urol] 2024 Apr; Vol. 31 (4), pp. 422-429. Date of Electronic Publication: 2024 Jan 09.
DOI: 10.1111/iju.15383
Abstrakt: Background: Kidney transplantation is a well-established alternative in renal replacement therapy. Compared with hemodialysis, low-immunological-risk kidney transplantation can reduce the medical treatment costs associated with end-stage renal disease. However, there are few reports on whether high-immunological-risk kidney transplantation reduces the financial burden on governments. We investigated the medical costs of high-immunological-risk kidney transplantation in comparison with the cost of hemodialysis in Japan.
Methods: We compared the medical costs of high-immunological-risk kidney transplantation with those of hemodialysis. 15 patients who underwent crossmatch-positive and/or donor-specific antibody-positive kidney transplantations between 2020 and 2021 were enrolled in this study. The patients received intravenous immunoglobulin, plasmapheresis, and rituximab as desensitizing therapy.
Results: Acute antibody-mediated rejection was detected in nine (60%) recipients, while there were no indications of graft function deterioration during the follow-up. For each patient, the transplant hospitalization cost was 38 428 ± 8789 USD. However, the cumulative costs were 59 758 ± 10 006 USD and 79 781 ± 16 366 USD, at 12 and 24 months, respectively. Compared with hemodialysis (34 286 USD per year), high-immunological-risk kidney transplantation tends to be expensive in the first year, but the cost is likely to be lower than that of hemodialysis after 3 years.
Conclusions: Although kidney transplantation is initially expensive compared with hemodialysis, the medical cost becomes advantageous after 3 years even in kidney transplant recipients with high immunological risk.
(© 2024 The Japanese Urological Association.)
Databáze: MEDLINE
Externí odkaz: